Beyond business as usual for lymphatic filariasis mass drug administration in hotspot districts

Background: This study aimed to validate the 'Engage & Treat' (E&T) and 'Test & Treat' (T&T) strategies to treat individuals who seldom or never participate in lymphatic filariasis mass drug administration (LF MDA). Methods: The study was conducted in a hotspot district of Ghana, with 20 years of MDA. Treatment registers documenting participation were used to identify non-participating individuals. Individuals willingly accepting treatment were given the drugs (E&T). Those who refused treatment were offered testing using the filaria test strip (FTS) and further engaged to receive treatment if positive (T&T). A portion of the E&T participants were also tested. Results: Overall, 25 068 individuals who missed the last MDA were identified; 93.13% accepted the drugs; 9958 people were tested, revealing an overall prevalence of 7.26% (95% CI 6.76 to 7.79%). Positivity was higher in T&T (12.10%; 95% CI 10.43 to 13.92%) than in the E&T group (6.47%; 95% CI 5.96 to 7.01%). The odds of testing positive were higher (OR=1.99; 95% CI 1.66 to 2.39; p<0.0001) among the T&T population and missing three consecutive MDAs (OR=2.22; 95% CI 1.86 to 2.64; p<0.0001). Conclusions: The study confirms the validity of the strategies in addressing the challenges with non-treatment during LF MDA. Their implementation in areas of persistent transmission can support elimination in these settings.